2026 年第 3 期 第 21 卷

心脏外科开胸术后合并消化道出血患者出血后30天内死亡的危险因素分析

Risk factor analysis of mortality within 30 d after gastrointestinal bleeding in patients undergoing thoracotomy in cardiac surgery

作者：杜海琳孙亚梅张杰

英文作者：Du Hailin Sun Yamei Zhang Jie

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：消化道出血；心脏外科开胸术后；30d内死亡；危险因素

英文关键词：Gastrointestinalbleeding;Post-thoracotomyincardiacsurgery;Mortalitywithin30d; Riskfactors

• 摘要：

• 目的 探讨心脏外科开胸术后合并消化道出血（GIB）患者出血后30 d内死亡的危险因素。方法 回顾性纳入2017年1月至2024年1月在首都医科大学附属北京安贞医院心脏外科行开胸手术且术后30 d内发生GIB的成人患者271例，以出血后30 d内全因死亡为主要终点，根据主要终点事件，将患者分为存活组（149例）与死亡组（122例）。2组间进行单因素Logistic分析，随后纳入协变量构建多因素Logistic模型判断出血后30 d内死亡的危险因素。结果 死亡组女性、外周血管疾病比例、EuroSCOREⅡ评分、出血前再次开胸手术、出血前脑血管病、出血前肺部感染、出血前休克、出血前血管活性药物支持、出血前机械通气、出血前连续性肾脏替代治疗、出血前主动脉内球囊反搏或体外膜氧合比例、出血前红细胞输入量、出血前稳定期国际标准化比值、出血后首次国际标准化比值均高于存活组，高血压病比例、出血前稳定期血小板计数、出血时收缩压、出血后首次血小板计数均低于存活组（均P<0.05）。多因素Logistic回归分析结果显示，外周血管疾病为心脏外科开胸术后合并GIB患者出血后30 d内死亡的独立危险因素（比值比=2.77，95%置信区间：1.28～6.19，P=0.011）；出血时收缩压每升高10 mmHg（1 mmHg=0.133 kPa，比值比=0.74，95%置信区间：0.63～0.85，P<0.001）、出血后首次血小板计数每升高50×109/L（比值比=0.73，95%置信区间：0.61～0.86，P<0.001）与死亡风险降低相关。结论 在心脏外科开胸术后合并GIB的患者中，外周血管疾病与出血后30 d内死亡风险增加独立相关，出血时较高收缩压、出血后首次血小板计数较高与出血后30 d内死亡风险降低相关。

• Objective To investigate the risk factors for mortality within 30 d after gastrointestinal bleeding (GIB) in patients undergoing thoracotomy in cardiac surgery. Methods A total of 271 adult patients who underwent thoracotomy in the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University and developed GIB within 30 d after surgery from January 2017 to January 2024 were retrospectively enrolled. All-cause mortality within 30 d after GIB was set as the primary endpoint. According to the occurrence of the primary endpoint event, the patients were divided into the survival group (149 cases) and the death group (122 cases). Univariate Logistic analysis was performed between the two groups, and then covariates were included to construct a multivariate Logistic model to identify the risk factors for mortality within 30 d after GIB. Results The proportions of female patients, peripheral vascular disease, European System for Cardiac Operative Risk Evaluation Ⅱ (EuroSCORE Ⅱ), rethoracotomy before bleeding, cerebrovascular disease before bleeding, pulmonary infection before bleeding, shock before bleeding, vasoactive drug support before bleeding, mechanical ventilation before bleeding, continuous renal replacement therapy before bleeding, intra-aortic balloon pump or extracorporeal membrane oxygenation before bleeding, red blood cell transfusion volume before bleeding, stable international normalized ratio (INR) before bleeding, and the first INR after bleeding in the death group were significantly higher than those in the survival group, while the proportion of hypertension, stable platelet count before bleeding, systolic blood pressure at the time of bleeding, and the first platelet count after bleeding in the death group were significantly lower than those in the survival group (all P<0.05). Multivariate Logistic regression analysis showed that peripheral vascular disease was an independent risk factor for mortality within 30 d after GIB in patients undergoing thoracotomy in cardiac surgery (odds ratio=2.77, 95% confidence interval: 1.28-6.19, P=0.011). Every 10 mmHg increase in systolic blood pressure at the time of bleeding (1 mmHg=0.133 kPa, odds ratio=0.74, 95% confidence interval: 0.63-0.85, P<0.001) and every 50×109/L increase in the first platelet count after bleeding (odds ratio=0.73, 95% confidence interval: 0.61-0.86, P<0.001) were associated with a decreased risk of mortality. Conclusion In patients undergoing thoracotomy in cardiac surgery complicated with GIB, peripheral vascular disease is independently associated with an increased risk of mortality within 30 d after GIB, while higher systolic blood pressure at the time of bleeding and higher first platelet count after bleeding are associated with a decreased risk of mortality within 30 d after GIB.